Corey's Story: Pediatric Neurology

8/8/2011

For Corey Wright, a 13-year-old boy from Morristown, the night of October 13, 2010, started off like any other autumn evening. After school, Corey did homework, talked on the phone, played Xbox and ate dinner with his family. Corey’s parents, Carrie and Shane Wright, were not concerned when he complained of a stiff neck since he had just returned from a weekend camping trip with the Boy Scouts.

“We thought it was a muscle spasm or the result of an active weekend with the boys, not anything serious,” Carrie said. Despite his discomfort, Corey continued his normal activities and even jumped on the trampoline with his brothers and sisters. When his pain progressed after dinner, his parents gave him pain reliever and told him to lie down.

Suddenly Corey started screaming and complaining of shooting pains throughout his body. “Corey is not a complainer so I knew something must be terribly wrong,” Carrie said. Corey insisted on taking his shirt off but realized he was not able to raise his right arm.

While the Wright family waited on an ambulance, Corey began to slur his speech. “Within 30 minutes, he had lost complete control of the right side of his body. Within an hour and half, he was not able to speak at all and had lost control of his arms and legs,” Carrie said.

A diagnosis is made

An ambulance rushed Corey to Jefferson Memorial Hospital in Jefferson City. Corey underwent a spinal tap and several scans, but the results were inconclusive. “Corey was in so much pain. I just kept asking ‘where has my child gone?’ He was perfectly healthy just hours before,” Carrie said. Corey was then transported by ambulance to the Emergency Department at East Tennessee Children’s Hospital. A team of doctors, including pediatric neurologist Dr. Karsten Gammeltoft, were waiting on the Wrights when they arrived. After examining Corey, Dr. Gammeltoft immediately suspected transverse myelitis, a neurological disorder caused by the inflammation of the spinal cord. Corey underwent several scans and soon was diagnosed with idiopathic transverse myelitis and admitted to the Goody’s Pediatric Intensive Care Unit.

Symptoms of transverse myelitis develop rapidly and include limb weakness, sensory disturbance, back pain and bowel/bladder dysfunction. Corey’s case of transverse myelitis was idiopathic, meaning the disorder occurred without an apparent underlying cause. It is assumed to be the result of abnormal activation of the immune system against the spinal cord that could potentially have been caused by an underlying virus or an environmental factor.

The section of Corey’s spine that was inflamed affects breathing so Corey had to rely on a breathing tube. “We knew it was going to be a long road of recovery. The doctors told us to expect months or maybe a whole year of recovery. We decided we weren’t going to let this beat us,” Carrie said.

Corey was initially treated with a high dose of steroids to reduce the inflammation in his spinal cord but his body did not have a response so doctors looked for other options. Corey’s primary care physician, Dr. Regina Phillips, knew Dr. Benjamin Greenberg, a pediatric transverse myelitis specialist, in Dallas, Texas who suggested a treatment called plasmapheresis. The team of critical care doctors at East Tennessee Children’s Hospital decided to try the treatment, which removed Corey’s blood through a small tube in his groin and separated blood cells from the plasma. The blood cells were returned to his body immediately while the plasma was treated and then returned. “They could only do the treatment every other day, and the doctors told us we would be able to see noticeable improvement after four treatments,” Carrie said. “The morning after the fourth treatment he was able to move his legs and squeeze my hand; it was a miracle.”

With improvement comes rehabilitation therapy

Despite Corey’s improvement, his family was worried they were going to have to travel to another city for further treatment and rehabilitation. “The team of critical care doctors fought for us to stay here. It was wonderful to be able to stay close to the whole family. We were incredibly thankful that we could receive treatment at East Tennessee Children’s Hospital and at the Rehabilitation Center,” Carrie said.

Corey improved after each plasmapheresis treatment and completed seven treatments before he was released from the Children’s Hospital. Transverse myelitis usually does not reoccur in patients, and Dr. Gammeltoft firmly believed Corey would not have a relapse. “By the time I left the hospital, I was able to walk a little bit and my tolerance level was up,” Corey said. Corey required three types of rehabilitation therapy and the Children’s Corner program at Children’s Hospital Rehabilitation Center was able to meet all his medical needs.

Corey’s first day of intensive therapy at Children’s Corner was on November 15, 2010, almost exactly a month since he was diagnosed with transverse myelitis. Corey worked with a physical therapist several times a day to build his strength. “The physical therapist made it fun. My favorite thing was strength training in the pool. I swam laps, played games and even lifted water weights. They were hard at first, but as I got my strength back they became easier,” Corey said. He also played basketball, walked on the treadmill, played Wii games and walked outside for terrain training. Each exercise was designed specifically for Corey to build his strength and endurance.

His physical therapist also worked to strengthen Corey’s right side, which was considerably weaker than his left and affected the way he walked. “I told my physical therapist that I wanted to be able to run again, and on the last day of my training I was able to run down the hall,” Corey said.

The teenager also worked with an occupational therapist to help him learn how to do everyday activities again like brush his teeth and dress himself for school. “I didn’t realize what an occupational therapist did, but it was fascinating. She worked with him on his handwriting, schoolwork and even taught him how to transfer money from one container to another. She also had him work with play dough to strengthen the palms of his hands,” Carrie said.

Since Corey relied on a breathing tube while in the hospital, his voice was very weak. A speech therapist worked with Corey on many exercises that required him to project his voice. During the hardest projection exercise, Corey sat on one side of a closed door and the speech therapist sat on the other. Corey had to speak loud enough so that he and the therapist could have a conversation through the closed door. The therapist also had him do breathing exercises like blowing bubbles and blowing a whistle to strengthen his lungs. Corey excelled in speech therapy and soon his voice was as strong as it was before he became sick.

Corey was released from intensive rehabilitation therapy the day before Thanksgiving. “God really performed a miracle when he healed Corey so quickly. We were prepared to continue treatment and therapy for a year, and he was healed within a month,” Carrie said. “We only notice every now and then that the right side is still a little weaker. We are so grateful that Corey is healthy and happy,” Carrie said.

Corey is back to his normal, active self and was grateful to get back to his Boy Scout activities; Corey eventually wants to become an Eagle Scout, the highest rank attainable in the Boy Scouting program.